Transcript File

MAT 119 Chapter 15
Part 1
Abbreviation
Solution Component
D
Dextrose
W
Water
S
Saline
NS
NaCl
Normal Saline
(0.9% sodium chloride)
Sodium Chloride
RL
Ringer’s Lactate
LR
Lactated Ringer’s
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The abbreviation letters indicate the
solution components
The numbers indicate the solution strength
or concentration of the components.
Examples: D5W, D5NS, D10W
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D5W – means dextrose 5% in water
◦ 5% Dextrose Injection (p. 357 figure 15.1)
◦ This means the solution strength of the solute
(dextrose) is 5%.
◦ The solvent is water
◦ Each 100 mL of water contains 5 g of dextrose
5% = 5 = 5 g
100 100 mL
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An order states: D5NS 1000 mL IV over 8h
◦ Interpretation: Administer 1000 mL 5% dextrose
in 0.9% sodium chloride over 8 hrs.
◦ Supplied as 5% dextrose and 0.9% sodium
chloride (NaCl)
◦ Normal Saline is a common term for 0.9% sodium
chloride
◦ The concentration of sodium chloride in normal
saline is 0.9 g (or 900 mg) per 100 mL of
solution
◦ If the concentration is NOT 0.9%, it is NOT
normal saline! It is sodium chloride!
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0.45% NaCl or written ½ NS
◦ This is ½ strength of 0.9% sodium chloride
◦ This solution is sodium chloride!
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0.225% NaCl or written ¼ NS
◦ This is ¼ strength of 0.9% sodium chloride
◦ This solution is sodium chloride!
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To maintain fluid balance (replace insensible
water losses + sweat + urine output when
patients are NPO or otherwise unable to drink
as much as they need to for replacement)
To replace volume losses (i.e., blood volume
loss due to surgery, losses from the GI tract
from vomiting or diarrhea)
To repair imbalances (electrolyte imbalances,
acidosis/alkalosis).
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Isotonic solutions are NS and LR.
These solutions have the same osmolarity of blood so
when you administer them IV, the fluid stays in the
vascular system re-expanding it.
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Hypertonic solutions are high osmolarity
solutions.
Greater than 0.9% sodium chloride (NS) 3% & 5% NS
Greater than Dextrose 5%, like D25W or D50W, and
D5 plus any other solutions, like D5LR, D5NS,
D5 1/2NS etc.
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Hypotonic solutions are watery solutions.
◦ These are solutions less than 0.9% sodium chloride
(NS) and D5W.
◦ D5W when it enters the blood stream has the dextrose
metabolized leaving water behind to seep out to the
cells.
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Peripheral
◦ Rate of infusion should not exceed ~200 mL/h
◦ Maximum glucose concentration is 12%
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Central line
◦ larger vein usually in chest (ex. Subclavian, jugular
in neck)
◦ Accommodates larger concentrations and volumes
of fluid
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PICC line
◦ A peripheral vein used to access a central vein
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www.smith-nephew.com
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jpizzlll.org
bobcowart.blogspot.com
Breastcancer.about.com
Phoenix5.org
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kidney-beans.blogspot.com
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jmmultiplemyeloma.blogspot.com
www.drypro.ie
www.cs.cmu.edu
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The nurse is responsible for monitoring the
patient and IV site
Complications
◦ Phlebitis – the vein becomes irritated,
red, painful, warm and cordlike
◦ Infiltration – the IV catheter becomes
dislodged from the vein & the IV fluid
infuses into the subcutaneous tissue
(cool and puffy skin)
◦ Infection – sites need to be changed per
hospital policy
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Ordered by physician
Nurse’s responsibility to regulate, monitor,
and maintain flow rate
2 definitions:
◦ mL/hr – an infusion pump
◦ gtt/min – manually counted (watch count)
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Pump: mL/h
 > 1 hr: total mL = mL/hr
total hr
 < 1 hr: total mL x 60 min/hr = mL/hr
total min
Drops per Min: gtt/min
 total mL
x drop factor gtt/mL = gtt/min
total min
> 1 hr:
 Regulate an IV volume by electronic infusion
pump or controller calibrated in mL per hour
 THINK: the design of the pumps is to be set in
ml/hr ONLY
Total mL ordered
 mL/h
Total h ordered
(rounded to a whole number)
“Review rules of rounding”
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Order reads:
D5W 250 mL IV over the next two hours by
infusion pump
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• Use one of the formulas: Volume
Time
Ratio/Proportion
Total volume (mL)
Total time (hours)
Total mL ordered  250 mL
 125mL/h
Total h ordered  2 h
250 mL x mL

2h
1h
– Therefore, set pump at 125 mL per hour
125 mL/h
Total mL ordered
 60 min/h  mL/h
Total min ordered
(rounded to a whole number)
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Order:
◦ Ampicillin 500 mg IV in 50 mL D5 12 NS in 30 min
by controller
◦ (Note: physician’s orders will not state to use an
infusion pump, controller or drop factor; this is
done for the purpose of understanding how in
infuse medications.)
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Calculate
Total mL ordered
 60 min/h  mL/h
Total min ordered
50 mL 60 min

30 min
1h
 100 mL/h
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If an infusion pump is not used, the nurse
must calculate the ordered IV rate
Based on the number of drops per minute
(gtt/min)
The gravity flow rate depends in the IV
tubing calibration called the drop factor
(gtt/mL)
Answer MUST be in a whole number!
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The drop factor is the number of drops per
milliliter (gtt/mL) that an IV tubing set will
deliver
Standard or MACROdrop IV tubing has a
drop factor of 10, 15, or 20 gtt/mL
MICROdrop IV tubing has a drop factor of
60 gtt/mL – used for infusion pumps
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Formula for IV flow rate for manually
regulated IVs ordered in mL per hour or for
minutes
Volume (mL)
Time (min)
Calibration or drop factor (gtt/mL)
V
 C (or DF)  R
T
Rate (gtt/min)
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Formula for Infusion Time gtt/min
Total mL
x drop factor gtt/mL = gtts/min
Time (in minutes)
Example: 1000 mL NS to run over 12 hours
Tubing is 15 gtt/mL = 20.8 = 21 gtt/min
1000ml x 15gtt/mL over 720 min = 15000/720
=15,000 divided by 720 = 20.8 = 21 gtt/min
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Carry calculations to the tenths place
Round drops per min to the nearest whole
number
Watch
◦ Count only whole drops
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Calculation of gtt/min from mL/hr
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Physician orders:
◦ D5W IV at 125 mL per hour
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Infusion set is calibrated for a drop factor
of 10 drops per mL
Calculate IV flow rate in drops per min
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Calculation of gtt/min from mL/hr
Notice that the mL and hr cancel out, leaving drops per min
125 mL 10 gtt/mL

1 hr
60 min/hr
 20.8 gtt/min
125mL/hr x 10 gtt/mL = 20.8 gtt/min
60 min/hr
Use your watch to count drops and adjust roller clamp
to deliver 21 drops per min
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When IV drop factor is 60 drops per mL
(microdrip sets)
◦ Flow rate in drops per min is same as
volume ordered in mL per hour
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Order: D5W NS IV at 50 mL/hr
 Drop factor is 60 gtt/mL
 Notice: order of 50 mL/hr is the same as
the flow rate of 50 gtt/min
ONLY when drop factor is 60 drops per mL
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50 mL 60 gtt/mL

1 hr
60 min/hr
50 mL/hr x 60 gtt/mL ÷ 60 min/hr = 50 gtt/min
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Do not do shortcut method
Do not do adjusting IV flow rate
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